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Mobile Rehabilitation to Extend Outpatient Recovery, Spark More Personalized Care

Shepherd Center leads mRehab research efforts to transform delivery of outpatient rehabilitation.

The way the world of rehabilitation is moving, care is increasingly being delivered on an outpatient basis. With that in mind, there is an urgent need to support patients’ recovery outside of the clinic walls, explains Mike Jones, Ph.D., vice president of research and technology at Shepherd Center.The Future of mRehab

One viable solution is mobile rehabilitation, or mRehab, the delivery of services and support for home-based rehabilitation using innovative mobile information and digital health technologies. mRehab includes app-based therapy, sensor-based activity tracking and gamified exercises, and advanced monitoring that allows therapists to adjust treatments between outpatient visits. Dr. Jones and several collaborators recently received a multi-million dollar grant to develop and study mRehab solutions that optimize recovery. Researchers say a shift to this type of a model has the potential to transform and extend the rehabilitation care patients receive in clinic.

Dr. Jones explains that while most people with health insurance have a defined outpatient rehabilitation benefit, many plans impose limits. For example, someone may only get 12 outpatient visits, regardless of how serious their condition or injury.

“If we do it right, mRehab could address key challenges of access and affordability of rehabilitation services for people with disabilities,” Dr. Jones says. “Ultimately, we want better outcomes and practical solutions to make outpatient visits more efficient and to support ongoing care after someone’s reimbursed visits run out.”

How? For starters, mRehab interventions:

  • Use remote sensor technology to gather real-time data to gauge if and how well a patient is doing their exercises instead of relying on their own assessment and recall during clinic visits;
  • Present data to the patient and clinician in an actionable manner;
  • Allow the clinician to adapt and tailor prescribed home-based therapy in between visits to make sure patients are maximizing their recovery and progression of exercises; and
  • Often marry rehabilitation and gaming to engage and motivate patients to stick with their therapy.

“It’s a new era for rehabilitative medicine,” Dr. Jones says. “We will now be able to send people home with instructions and instrumented exercise equipment that can actually measure and monitor what they are doing at home and, in some cases, adjust exercises as they go. The hope is that by using mRehab, defining new algorithms and predictive management tools, patients can get the most mileage out of their rehab visits.”

As part of the $4.5 million five-year grant, the Rehabilitation Engineering Research Center on ICT Access for Mobile Rehabilitation (mRehab RERC) at Shepherd Center will complete nine research projects to help advance the mRehab field and test how these technologies can be seamlessly embedded into practice. Central to their efforts will be to create a central repository – what researchers are calling a big data lake – that will fold in historic data from 500,000 

individuals, as well as new data from patients across three centers.

Applying “Big Data” analytic methods, researchers will be able to look for trends and gain insights into:

  • The factors associated with or predictive of successful outcomes;
  • How to best tailor strategies to improve exercise adherence, engagement and outcomes by patient type; and
  • What algorithms can help optimize patients’ progress based on tracking their participation and performance at home.

The idea for the Center came after Dr. Jones invited David Reinkensmeyer, Ph.D., a professor of engineering and neuroscience at the University of California at Irvine, to visit Shepherd and speak about his research. Dr. Reinkensmeyer and his former graduate students are the brains behind two popular neurorehabilitation devices commercialized by their start-up company FlintRehab Devices:

  • MusicGlove, a sensorized glove and Guitar Hero-style video game that allows wearers, often stroke survivors, to perform hand and finger exercises to music to regain movement; and
  • FitMi, a program that uses two sensorized pucks that can be held or set on a table in front of a mobile device to direct various exercises that are tailored to a patient’s function and recovery. The app adjusts what the patient is doing in real time based on their performance.The future of mHealth

Between these two devices, FlintRehab has logged more than 70 million practice movements. Shepherd Center will partner with Dr. Reinkensmeyer, FlintRehab Devices and another rehab tech company, Pt Pal, that has developed a home therapy management platform for outpatient therapists. Outcomes of this work will include the development of a new therapy platform for Sensor-Enhanced Activity Management (SEAM) that combines the benefits of FlintRehab Devices and Pt Pal. The goal is to create a platform with algorithms that makes mRehab interventions simple to incorporate into practice.

“Therapists don’t have time to manage and analyze the vast amount of data that can be measured, so we have to give them tools that make it easy for them to interpret and adjust the therapy program,” Dr. Reinkensmeyer says. “The idea is to build on the momentum from clinical interactions and progress patients based on what they are doing at home to maximize their rehabilitation therapy, and in the process, make home exercise more interesting and fun.”

Research will range from early usability studies to studies that will evaluate and compare the effectiveness of sensor-enhanced home exercise devices and machine-learning algorithms in practice with standard outpatient rehab services.

“Our hope is that we will help empower individuals with disabilities and give them greater indepen

dence in their ongoing rehabilitation exercise and health maintenance,” Dr. Reinkensmeyer says. “In pooling collective data, we hope to identify trends including what types of patients do best with what types of home exercise programs, in order to establish best practices.”

In addition to UC-Irvine, other mRehab RERC collaborators include Duke University, Moss Rehabilitation Research Institute, Pt Pal and FlintRehab.

For more information, click here.

Written by Amanda Crowe, MA, MPH.

Photos courtesy of

About Shepherd Center

Shepherd Center provides world-class clinical care, research, and family support for people experiencing the most complex conditions, including spinal cord and brain injuries, multi-trauma, traumatic amputations, stroke, multiple sclerosis, and pain. An elite center recognized as both Spinal Cord Injury and Traumatic Brain Injury Model Systems, Shepherd Center is ranked by U.S. News as one of the nation’s top hospitals for rehabilitation. Shepherd Center treats thousands of patients annually with unmatched expertise and unwavering compassion to help them begin again.